Important Steps of Professional Medical Claims Processing

Medical claims processing can be straightforward to complex process, depending on the circumstances. Typically, a medical billing insurance claim process would start when a healthcare provider or practice provides treatment to a patient and then sends the bill of services to the designated payer. This designated payer is usually the patient’s health insurance company. The payer will then evaluate the claim based on their set standards along with different determining factors in order to verify services that it will reimburse.

Medical claims processing only becomes complex when there are complications in the claim, such as insufficient coverage or the failure of a patient to stay current with dues. In a perfect world, the steps to a medical billing procedure are quite simple:

• The patient receives a medical service from a licensed provider

• The services are recorded and assigned the appropriate codes by a medical coder

• ICD codes are to diagnoses as CPT codes are to treatments.

• A summary of services rendered is generated through the entered code sets, which in turn makes up the bill.

• The patient demographic data along with his or her insurance information are then added to the bill; and

• The claim is now ready for processing.

Medical claims processing can be done either electronically or manually. Various technical protocols as well as industry standards must then be followed so that insurance claims can be delivered accurately and expediently between the payer or the insurance provider and the medical practice. Different medical billing services use various approaches to medical claims processing. Others may use the manual or paper route, while more modern service providers do everything electronically with the help of increasingly reliable software programs and applications. Today’s healthcare providers as well as insurance companies subscribe to electronic claim systems as they offer faster and more accurate, (sometimes even cheaper) processing than traditional manual methods.  

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Submit Your Claims Through EDI to Reduce Processing Delays

EDI or the Electronic Data Interchange has made life simpler for medical professionals in several ways. The efficient way it transfers information between two sources, either the physician to the patient or the claims department, makes it simpler and faster. The EDI set-up works at providing accurate and reliable information, through electronic transfer, at a minimum possible time.

Here are some of the major benefits which show why electronic claim submission is one of the best ways to submit claims.

• EDI is fast and efficient- The new technology has changed the way we operate. No big documentation, no spending grueling hours struggling to meet data, or submission of claims. The EDI offers us swift and accurate claim processing, without delay.

• EDI is cost-effective- Long hours put into filing, documentation, storage, or in papers used to file these claims, or documenting information, all can be saved through EDI set-up. Just an efficient system in place, either in-house, or outsourced, can help in dealing with the mess, albeit without the clutters or the cost spent on manpower. Using electronic claim processing is, therefore, definitely cost-effective.

• Accurate and reduces claim denials – Any electronic system, when handled by an experienced player, and with all systems in place, can give accurate results. As a reward, one can expect precise and accurate results, and fewer claim denials, which is a bane of any clinical experience. 

• Reduces manpower – Documentation and data entry are something that includes a huge manpower to handle it. When you run a bigger setup, it goes without saying that there are innumerable claims every day, and thus, you would need several people to handle it effectively. EDI, however, has reduced this necessity, with its efficiency.

The Electronic Data Interchange claims to have reduced the cost by almost 35% and also the processing time by more than half (61%). Shifting your claim processes to EDI set-up can, therefore, help you process all clinical transactions successfully, and also at a reduced cost and time.

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Increase Your Return on Investment With Offshore Medical Billing

Medical billing can be a cumbersome and time-consuming process, what with claims to address, denials to redress, and applications to process. All this can take a whole lot of effective work hours from your employees. However, as per the norms, it is essential to produce perfect, and code-corrected medical bills for denial management and approvals. More so than ever, healthcare centers and clinics are outsourcing their billing systems to ensure efficient and accurate processing of bills.

Outsourcing today has become quite common among professionals working in the medical sector. One of the essential reasons behind its success among the health care professionals is that it provides a comprehensive package to the clinics. Not only the outsourcing agencies handle the billing problems, but also ensure they employ best professionals depending upon your requirement. It becomes the responsibility of an outsourcing agency to recruit, train, and employ experts to deal with all aspects of the billing. As a result, the clinic or the health care center will not have the responsibility of recruitment or training of professionals. Think of the space, all the troubles and cost it will save in the process.

As for the cost, it is not only the employment issues or the recruitment process of the professionals that involves money. There is training to consider, redressing any claim denials, the time-consumed in answering to these denials, and many more such smaller issues that crop up with the billing can sit heavy on the profits.

Similarly, with the medical coding changing year after year, and new versions of coding systems introduced, it becomes difficult to keep track of everything, and also run the essential part of the clinic- treating patients for their illness.

Hence, outsourcing offshore medical billing can reduce the overhead costs, prevent delays, and take care of all mundane, and crucial parts of the billing, without involving your employees, thus, increasing your return on investment.

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Prevent Medical Coding Errors by Complying to HCC Medical Coding Audits

Here’s a fact: The main causes of medical claim denials are medical coding errors. These human errors are very easy to make because new codes are routinely introduced. There was a dramatic increase in claim denials in 2015, because of the transition to new codes. Add to this the fact that in-house medical encoders also distracted by the many other functions they perform in the hospital or clinic, and it’s easy to see why so many mistakes are made. How can healthcare providers avoid medical coding errors? Below are some essential tips. 

• Stay updated with the latest diagnosis codes and current procedures. Codes will probably continue to evolve in the future. Coders in the healthcare industry should always update their codebook and keep up with the changes. This way, they are always on the same page as insurance providers and clients. 

• Do not use truncated codes. While speed is necessary, the coder's goal should be accuracy. There should not be any place for truncated codes. Physicians should also be careful in providing precise clinical documentation to help coders select the appropriate or specific diagnosis codes.

• Read the entire medical chart note. Some coders only read the header or the summary of the chart note before coding. This is not a good practice because the expected procedure may still change as the doctor orders more examinations or tests on the patient. It's always better to double check the chart note, too. 

HCC medical coding errors are a waste of time and money. On their own, it is often very difficult for hospitals and medical practices to implement a streamlined process for HCC medical coding audits. The good news is that you can always outsource these functions to third-party providers that offer HCC medical coding services. They can dramatically improve your revenue cycle management with their efficiency and accuracy. To get the best quality service, choose a trusted company with a medical coding team that has AAPC certificated Coders.

Medical Coding Services: Avail Faster Claims with Accurate Processing

The medical coding process is no doubt complicated and time-consuming, and the ever-changing legislations and requirements make it even more compound. If you are still doing it in-house, you are probably losing precious time and money. Some of the most successful Medical Billing Companies today choose to outsource this function to expert third-party company that offer medical coding service because they realize the positive impact of accurate processing on their bottom line.

Outsourcing your medical coding functions does not mean that you are no longer ‘in control.’ In fact, it puts you in a better position than ever because it ensures that this administrative aspect is never overlooked. Outsourcing ultimately enhances the experience you provide to your end clients. And if there are no errors, payment of claims is faster.

Outsourced medical coding service can lead to accurate processes and faster claims. To ensure that you can truly enjoy these benefits, make sure that you are partnering with an o offshore Medical Billing service that has the following credentials:

1. Expert coders

The best outsourcing companies invest in training their employees on the latest codes and guidelines in the industry. Their level of speed and accuracy is better, and their processes are designed to minimize coding errors. When you work with them, you work with people who devote 100% of their time to medical coding—they are not distracted by other client relations activities.

2. Various coding services

The best outsourcing company is not only knowledgeable in one type of medical coding service, but in all of them. They are indeed capable of providing the best solutions catered to your organization's needs. These companies also have disaster recovery strategies to guarantee uninterrupted operations.

3. Accreditation

Most importantly, the best medical coding companies have accreditations and certifications. Choose one that is ISO certified and HIPAA compliant. Also, find out whether their coders are certified by American Association of Professional Coders (AAPC).

Common Reasons That Causes Claim Denials

It can get frustrating when claims are denied, but if the incident keeps occurring in your healthcare facility or organization, you may want to take a look at your processes and the way they are handled in your office. Timing issues, errors, and input oversights are among the reasons why some claims are denied. By being mindful of these incidents and following HCC medical coding standards, you could minimize denials and improve your approach to billing.

Hierarchical condition category (HCC) and risk adjustment coding is the payment model that identifies patients with chronic or serious illnesses, then designates a risk factor score to them according to factors like demographic details and health conditions. HCC medical coding was implemented in 2003 and mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. A patient’s health condition is identified using ICD-10 (International Classification of Diseases-10) diagnoses, which you submit to insurance companies when filing a claim. There are over 9,000 ICD-10 codes being mapped to 79 HCC codes.

HCC medical coding errors are among the reasons why claims are denied. By working with a seasoned team of AAPC-certified medical coders, you could minimize those mistakes and increase the accuracy of your claims. All coding must be audited before the charts are finalized. Claim denials may also occur when the claim is not up to the insurance company’s standards.  So, you need to make sure that the claims are made according to their regulations and that they are legible, specific, and complete with all the information required.

Missing information is another reason why a claim can be denied. Even a small detail left out can cause problems later on, especially when you are dealing with a detail-oriented insurance company. Keep in mind that some payers will look for minor specifics, such as the date of the medical emergency, onset, and the accident. A claim can be denied if it is not filed on time. Some providers of HCC medical coding services have a team of specialists who will make sure that the claims are submitted on time.

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Accounts Receivable Management: Top Tips to Get You Paid

As much as you want to get paid immediately, there are unavoidable circumstances that might prevent Insurance Company from paying you on time. In some cases, you might encounter an insurance company denying a claim. While there is no way to ensure that all claim can turn into money, you can minimize denials and inefficiency by considering account receivable management. It may sound complex, but it is actually simple when you work with the right billing partner, which you can outsource to save money and effort. Here are some tips to make accounts receivable management work for you:

• Outsource the service – An established and reputable medical billing company will provide you with an effective and highly trained AR team that can address the challenges in your cash flow. Their goal is to help you recover the funds owed to you as quickly as possible by accelerating cash flow and minimizing accounts receivable days by providing clean and error-free claims. They can analyze denied claims and regularly follow-up with patients and insurance companies on your behalf in case of any outstanding dues and claims.
  
  
• Do not wait – Go after late payments as soon as you notice them. The longer you ignore them, the more difficult it will be to collect. Accounts receivable management can help by following up, so you can focus more on your business.

• Follow-up insurance – Medical billing companies and healthcare providers lose money due to their inability to follow-up on any outstanding claims. When you lack manpower and the time to process insurance claims, you could risk losing a lot. So, consider working with a good Account receivable management team for assistance. Medical billing partner can aggressively follow-up all accounts with insurance companies to ensure the quick settlement of claims. They have the ability to monitor accounts receivables, too.
  
  
• Clean-up old accounts – Unresolved accounts receivables occur due to insufficient follow-up as a result of low manpower and backlogs. Account receivable management still analyzes previous reports and come up with ways to reduce debts and maximize collections.

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